Deal a death blow! HCC in cirrhotics – thrombotic complications: their frequency, characteristics, and risk factors

Introduction
The hepatocellular carcinoma (HCC), being the commonest primary cancer, holds the sixth slot in the list of common cancers worldwide. Thrombotic complications in the form of portal vein tumour thrombosis (PVTT) and bland portal vein thrombosis with HCC are common with a bad prognosis.

Aim
The study aims to determine the demographic, clinical, and biochemical parameters of HCC patients. The study also compares the clinical and biochemical parameters among patients having HCC with and without thrombotic complication. It further aims to assess the risk factors for thrombotic complication.

Material and methods
This was a retrospective study with a cross sectional design. Clinical and biochemical parameters among patients having HCC with and without thrombotic complication were determined. Tests of statistical significance were applied where a p-value < 0.05 was statistically significant

Results
Overall 118/305 (38.7%) patients of HCC had thrombotic complications. Most of the patients (74.5%) had PVTT whereas in 25.5% bland PVT was found. Higher age, male gender, greater tumour size, advanced stage of HCC (Okuda II, III), multifocal/massive tumour morphology and presence of oesophageal varices, upper GI bleeding, ascites and hepatic encephalopathy, and extrahepatic spread were found to be statistically significant for thrombotic complication (p < 0.05 for each).

Conclusions
Viral related HCC is a commonly reported problem. Thrombotic complication is mainly due to tumour thrombosis rather than bland portal vein thrombosis. Age, gender, greater tumour size, advanced stage of HCC (Okuda II, III), and multifocal/massive tumour morphology were important risk factors for thrombotic complication.